Ellemes Phuma-Ngaiyaye, MSC
Mzuzu University, Malawi


Bonding
is
considered
the
central
developmental force across the lifespan
(Feldman, Weller, Leckman, Kuint, & Edelman,
1999).
To enhance maternal-newborn attachment infants
need to be close to their mothers to cue their
needs and mothers need to be close to respond to
them (Karl et al., 2006).


Illness and hospitalization of a newborn baby
may interfere with the natural maternalinfant bonding and attachment process
Mothers struggle in getting connected with
their newborn babies due to restrictions in
the neonatal intensive care units

Studies show that nurses play an important
role
in
supporting
maternal-newborn
bonding while providing specialised care in
the neonatal intensive care unit (Kearvell &
Grant, 2010; Obeidat et al., 2009).

To explore the strategies used by nurses and
midwives to support maternal-newborn
bonding and attachment for mothers with
neonates admitted in a neonatal intensive
care unit




The study was conducted at a tertiary
hospital in the Eastern part of Malawi
Qualitative-in-depth
interviews
and
observations
15 participants were included-10 caregivers
and 5 nurses and midwives
Data was transcribed verbatim and content
analysis used to identify themes and patterns
in the text



The study met all the ethics requirements
Participants gave both verbal and written
consent
Integrity, privacy and confidentiality was
observed throughout the process


Results revealed that nurses use several
strategies to support maternal-newborn
bonding
Two themes
◦ Maternal-newborn interaction
◦ Maternal-nurse/midwife interaction

Nurses
and
midwives
use
different
approaches to promote maternal-newborn
bonding
◦ Breastfeeding-promoted a feeling of ‘being
together’
 “when the neonate is admitted in this unit…usually we
encourage
the
mother
to
be
coming
for
breastfeeding…feeding
their
babies,
it
is
important…for attachment as well” (Nurse-Midwife)

Caregiver participation in newborn’s routine
care
◦ Mothers involved in newborn care i.e. feeding,
touching, changing nappies
 “…they assist us, they also involve us…like feeding the
baby, we do it ourselves…sometimes changing
nappies. The nurses also encourage us to
communicate with the baby…playing with the baby…”
(Mother)

Kangaroo mother care
◦ Mothers with premature babies encouraged to do
KMC-to promote skin-to-skin contact-reciprocal
pleasure


The relationship between the mother and
nurse was viewed as important in supporting
a mother to establish a connection with her
infant
Friendly and sensitive nurses were viewed as
being supportive to the mothers
◦ guided and strengthened maternal responses to
their infants


Mothers reported developing a positive
connection with their newborn babies when
they were assisted by the nurses
The
nurses
and
midwives
provided
psychosocial support to the mothers
◦ Guidance, emotional support, encouragement and
education-maternal confidence

Continuous communication with mothers
◦ Mothers reported that nurses who continuously
communicated
with
caregivers
enhanced
attachment i.e.
 There was reduced anxiety among mothers
 Mothers understood the health status of their newborn
babies
 Mothers developed confidence in the care provided to
the newborn babies

Nurses and midwives who encourage mothernewborn interaction through breastfeeding,
maternal participation in newborn care, KMC,
in addition to maternal-nurse interaction
through
psychosocial
support
and
communication are key to promoting
maternal-newborn bonding


Nurses need to be active in initiating these
strategies to facilitate maternal-newborn
bonding and attachment
Nurses need adequate support and clear
guidelines for effective support to mothers
with newborn babies in the intensive neonatal
care units.

Obeidat, H.M., Bond, E.A. & Callister, L. C.
(2009). The Parental Experience of Having an
Infant in the Newborn Intensive Care Unit.
Journal Perinatal Education. 18; 23–29. doi:
10.1624/105812409X461199

Kearvell, H. & Grant, J. (2010). Getting
connected:
How
nurses
can
support
mother/infant attachment in the neonatal
intensive care unit. Australian Journal of
Advanced Nursing, Vol. 27; 75-82.